Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 12/2020

01-12-2020 | Obesity | Original Contributions

Bariatric Surgery Is Associated with a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults Below 50 Years of Age

Authors: Hisham Hussan, Arsheya Patel, Samuel Akinyeye, Kyle Porter, Dennis Ahnen, David Lieberman

Published in: Obesity Surgery | Issue 12/2020

Login to get access

Abstract

Background

Colorectal cancer incidence is rising in adults < 50 years old, possibly due to obesity. Having bariatric surgery (BRS) should hypothetically reduce this trend, but data are limited. This study compared trends of colorectal cancer (CRC) versus other obesity-related gastrointestinal cancers (OGCs) between morbidly obese and post-BRS subjects.

Material and Methods

This retrospective cohort study investigated OGC resection trends using the 2006–2013 National Inpatient Sample. Patients with prior BRS and non-BRS controls with body mass index ≥ 40 kg/m2 were included (n = 30,279 total). We divided OGCs into CRC and non-CRC OGCs (esophageal, stomach, liver, gallbladder, and pancreas). We calculated OGC resection trends in patients < 50 and ≥ 50 years old using the average annual percent change (AAPC).

Results

BRS patients with OGCs were younger (59.3 vs 62.3 years old), with more female gender (77.4% vs 57.1%) and White race (72.6% vs 67%) compared with controls (p < 0.05). The number of CRC resections increased across all ages in 2006–2013, especially rectal cancer for BRS patients (AAPC + 19.8%, p = 0.04). The steepest rise in early-onset CRC resections was after BRS versus a lesser increase in morbid obesity controls (AAPC + 18.7% and + 13.7%, respectively, p < 0.001). In contrast, non-CRC OGCs increased in our controls but not post-BRS. In a sensitivity analysis, estimated CRC incidence trends also increased post-BRS despite adjusting for increasing BRS prevalence.

Conclusion

Our findings suggest that bariatric surgery is associated with a persistent increase in early-onset CRC trends. Studies are warranted to validate our results and test the impact of bariatric surgery on early-onset CRC biological mechanisms.
Appendix
Available only for authorised users
Literature
1.
Bailey CE, Hu CY, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg. 2015;150:17–22.PubMedPubMedCentral
2.
Dwyer AJ, Murphy CC, Boland CR, et al. A summary of the fight colorectal cancer working meeting: exploring risk factors and etiology of sporadic early-age onset colorectal cancer. Gastroenterology. 2019;157:280–8.PubMed
3.
Kirzin S, Marisa L, Guimbaud R, et al. Sporadic early-onset colorectal cancer is a specific sub-type of cancer: a morphological, molecular and genetics study. PLoS One. 2014;9:e103159.PubMedPubMedCentral
4.
Liu PH, Wu K, Ng K, et al. Association of obesity with risk of early-onset colorectal cancer among women. JAMA Oncol. 2019;5:37–44.PubMed
5.
Palmer MK, Toth PP. Trends in lipids, obesity, metabolic syndrome, and diabetes mellitus in the United States: an Nhanes analysis (2003–2004 to 2013–2014). 2019;27:309–14.
6.
Asmbs Estimates of Bariatric Surgeries, (Accessed on 02/06/2017).
7.
8.
9.
Hussan H, Stanich PP, Gray 2nd DM, et al. Prior bariatric surgery is linked to improved colorectal cancer surgery outcomes and costs: a propensity-matched analysis. Obes Surg. 2017;27:1047–55.PubMed
10.
Krishna SG, Behzadi J, Hinton A, et al. Effects of bariatric surgery on outcomes of patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2016;14:1001–10.e5.PubMed
11.
Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and Cancer—viewpoint of the Iarc Working Group. N Engl J Med. 2016;375:794–8.PubMedPubMedCentral
12.
Anderson JE, Chang DC, Talamini MA. A nationwide examination of outcomes of percutaneous cholecystostomy compared with cholecystectomy for acute Cholecystitis, 1998-2010. Surg Endosc. 2013;27:3406–11.PubMed
13.
Anderson JE, Hemming AW, Chang DC, et al. Surgical management trends for cholangiocarcinoma in the USA 1998-2009. J Gastrointest Surg. 2012;16:2225–32.PubMed
14.
Carroll Jr JE, Hurwitz ZM, Simons JP, et al. In-hospital mortality after resection of biliary tract cancer in the United States. HPB (Oxford). 2010;12:62–7.
15.
Ejaz A, Sachs T, He J, et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the nationwide inpatient sample. Surgery. 2014;156:538–47.PubMedPubMedCentral
16.
Hussan H, Gray 2nd DM, Hinton A, et al. Morbid obesity is associated with increased mortality, surgical complications, and incremental health care utilization in the peri-operative period of colorectal cancer surgery. World J Surg. 2016;40:987–94.PubMed
17.
Lapar DJ, Stukenborg GJ, Lau CL, et al. Differences in reported esophageal cancer resection outcomes between national clinical and administrative databases. J Thorac Cardiovasc Surg. 2012;144:1152–7.PubMed
18.
Mishra A, Otgonsuren M, Venkatesan C, et al. The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the us Nationwide inpatient sample. Liver Int. 2013;33:1281–6.PubMed
19.
Neuwirth MG, Bierema C, Sinnamon AJ, et al. Trends in major upper abdominal surgery for cancer in octogenarians: has there been a change in patient selection? Cancer. 2018;124:125–35.PubMed
20.
Sarvepalli S, Garg SK, Sarvepalli SS, et al. Inpatient burden of esophageal cancer and analysis of factors affecting in-hospital mortality and length of stay. Dis Esophagus. 2018:31.
21.
Shi HY, Wang SN, Lee KT. Temporal trends and volume-outcome associations in periampullary cancer patients: a propensity score-adjusted nationwide population-based study. Am J Surg. 2014;207:512–9.PubMed
22.
Smith JK, McPhee JT, Hill JS, et al. National outcomes after gastric resection for neoplasm. Arch Surg. 2007;142:387–93.PubMed
23.
Solsky I, Friedmann P, Muscarella P, et al. Poor outcomes of gastric cancer surgery after admission through the emergency department. Ann Surg Oncol. 2017;24:1180–7.PubMed
24.
Taghizadeh N, Fortin M, Tremblay A. Us hospitalizations for malignant pleural effusions: data from the 2012 National Inpatient Sample. Chest. 2017;151:845–54.PubMed
25.
Velez-Serrano JF, Velez-Serrano D, Hernandez-Barrera V, et al. Prediction of in-hospital mortality after pancreatic resection in pancreatic cancer patients: a boosting approach via a population-based study using health administrative data. PLoS One. 2017;12:e0178757.PubMedPubMedCentral
26.
Wadhwa V, Jobanputra Y, Thota PN, et al. Healthcare utilization and costs associated with Cholangiocarcinoma. Gastroenterol Rep (Oxf). 2017;5:213–8.
27.
28.
29.
30.
Pope GD, Birkmeyer JD, Finlayson SRG. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002;6:855–61.PubMed
31.
Cardoso L, Rodrigues D, Gomes L, et al. Short- and long-term mortality after bariatric surgery: a systematic review and meta-analysis. Diabetes Obes Metab. 2017;19:1223–32.PubMed
32.
Wee CC, Huskey KW, Bolcic-Jankovic D, et al. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med. 2014;29:68–75.PubMed
33.
Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG, et al. Individualizing colonoscopy screening by sex and race. Gastrointest Endosc. 2009;70:96–108. 08.e1–24PubMedPubMedCentral
34.
Lieberman DA, Williams JL, Holub JL, et al. Race, ethnicity, and sex affect risk for polyps >9 Mm in average-risk individuals. Gastroenterology. 147(2014):351–8. quiz e14–5
35.
Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17:796–802.
36.
Afshar S, Kelly SB, Seymour K, et al. The effects of bariatric surgery on colorectal cancer risk: systematic review and meta-analysis. Obes Surg. 2014;24:1793–9.PubMed
37.
Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2019;269:95–101.PubMedPubMedCentral
38.
Derogar M, Hull MA, Kant P, et al. Increased risk of colorectal cancer after obesity surgery. Ann Surg. 2013;258:983–8.PubMed
39.
Mackenzie H, Markar SR. Obesity surgery and risk of cancer. 2018.
40.
Ostlund MP, Lu Y, Lagergren J. Risk of obesity-related cancer after obesity surgery in a population-based cohort study. Ann Surg. 2010;252:972–6.PubMed
41.
Tao W, Artama M, von Euler-Chelpin M, Hull M, Ljung R. Colon and rectal cancer risk after bariatric surgery in a multicountry Nordic cohort study. 2019.
42.
Hussan H, Drosdak A, Le Roux M, et al. The long-term impact of Roux-En-Y gastric bypass on colorectal polyp formation and relation to weight loss outcomes. Obes Surg. 2019;
43.
Faria SL, de Oliveira Kelly E, Lins RD, et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20:135–9.PubMed
44.
Freire RH, Borges MC, Alvarez-Leite JI, et al. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition. 2012;28:53–8.PubMed
45.
Maleckas A, Gudaitytė R, Petereit R, et al. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5:617–24.PubMedPubMedCentral
46.
Laurino Neto RM, Herbella FAM, Tauil RM, et al. Comorbidities remission after Roux-en-Y gastric bypass for morbid obesity is sustained in a long-term follow-up and correlates with weight regain. Obes Surg. 2012;22:1580–5.PubMed
47.
Schlesinger S, Lieb W, Koch M, et al. Body weight gain and risk of colorectal cancer: a systematic review and meta-analysis of observational studies. Obes Rev. 2015;16:607–19.PubMed
48.
Sellberg F, Willmer M, Tynelius P, et al. Four years' follow-up changes of physical activity and sedentary time in women undergoing Roux-en-Y gastric bypass surgery and appurtenant children. BMC Surg. 2017;17:133–3.
49.
Sondergaard Nielsen M, Rasmussen S, Just Christensen B, et al. Bariatric surgery does not affect food preferences, but individual changes in food preferences may predict weight loss. 26(2018):1879–87.
50.
Christou NV, Look D, MacLean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.PubMedPubMedCentral
51.
Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23:1922–33.PubMed
52.
Kant P, Sainsbury A, Reed KR, et al. Rectal epithelial cell mitosis and expression of macrophage migration inhibitory factor are increased 3 years after Roux-en-Y gastric bypass (Rygb) for morbid obesity: implications for long-term neoplastic risk following Rygb. Gut. 2011;60:893–901.PubMed
53.
Sainsbury A, Goodlad RA, Perry SL, et al. Increased colorectal epithelial cell proliferation and crypt fission associated with obesity and Roux-en-Y gastric bypass. Cancer Epidemiol Biomark Prev. 2008;17:1401–10.
54.
Afshar S, Malcomson F, Kelly SB, et al. Biomarkers of colorectal cancer risk decrease 6 months after Roux-en-Y gastric bypass surgery. Obes Surg. 2018;28:945–54.PubMed
55.
Anhe FF, Varin TV, Schertzer JD, et al. The gut microbiota as a mediator of metabolic benefits after bariatric surgery. Can J Diabetes. 2017;41:439–47.PubMed
56.
Guo Y, Liu CQ, Shan CX, et al. Gut microbiota after Roux-en-Y gastric bypass and sleeve Gastrectomy in a diabetic rat model: increased diversity and associations of discriminant genera with metabolic Changes. Diabetes Metab Res Rev. 2017;33
57.
Palleja A, Kashani A, Allin KH, et al. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota. Genome Med. 2016;8:67.PubMedPubMedCentral
58.
Hussan H, Clinton SK, Roberts K, et al. Fusobacterium's link to colorectal Neoplasia sequenced: a systematic review and future insights. World J Gastroenterol. 2017;23:8626–50.PubMedPubMedCentral
59.
Li JV, Reshat R, Wu Q, et al. Experimental bariatric surgery in rats generates a cytotoxic chemical environment in the gut contents. Front Microbiol. 2011;2:183.PubMedPubMedCentral
60.
de Kok TM, van Maanen JM. Evaluation of fecal mutagenicity and colorectal Cancer risk. Mutat Res. 2000;463:53–101.PubMed
61.
Hennessy DA, Quan H, Faris PD, et al. Do coder characteristics influence validity of Icd-10 hospital discharge data? BMC Health Serv Res. 2010;10:99.PubMedPubMedCentral
62.
Quan H, Parsons GA, Ghali WA. Validity of procedure codes in international classification of diseases, 9th revision, clinical modification administrative data. Med Care. 2004;42:801–9.PubMed
63.
Golinvaux NS, Bohl DD, Basques BA, et al. Limitations of administrative databases in spine research: a study in obesity. Spine J. 2014;14:2923–8.PubMed
64.
Tao W, Konings P, Hull MA, et al. Colorectal Cancer prognosis following obesity surgery in a population-based cohort study. Obes Surg. 2016;
Metadata
Title
Bariatric Surgery Is Associated with a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults Below 50 Years of Age
Authors
Hisham Hussan
Arsheya Patel
Samuel Akinyeye
Kyle Porter
Dennis Ahnen
David Lieberman
Publication date
01-12-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 12/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04902-9

Other articles of this Issue 12/2020

Obesity Surgery 12/2020 Go to the issue

Original Contributions

Validation of the GOAL Questionnaire as an Obstructive Sleep Apnea Screening Instrument in Bariatric Surgery Candidates: a Brazilian Single-Center Study

Biography

Biography: Christine Stier, M.D.

Original Contributions

Cost Analysis of Robotic Roux-en-Y Gastric Bypass in a Single Academic Center: How Expensive Is Expensive?

Obituary

In Memory of Nicola Scopinaro: a Great Friend and Mentor

Correction

Correction to: Esogastro-Pleuro-Bronchial Fistula: An Unusual Complication After Sleeve Gastrectomy

Multimedia Article

Single-Incision Transumbilical Laparoscopic Sleeve Gastrectomy with a Stomach Retractor in 20 Superobese Patients—a Video Vignette